Gone may be the days of the small town family doctor who keeps a community in good health. Whether this is due to a shortage of doctors across America is still up for debate, but one report suggests that this has a lot to do with the unequal distribution of the doctors we already have. Building off this earlier report, a new study suggests this distribution may also have something to do with who doctors marry.

New research published in the March 1 issue of JAMA found that in 2010, more than half of United States doctors are married to spouses who had a master's degree or higher. That fact alone reduces the odds of these physicians working in rural underserved areas by nearly 40 percent. Researchers said this may be because many of these physicians’ highly educated spouses have their own careers, which don’t offer opportunities to work in rural communities.

“It’s making it increasingly difficult for rural areas to attract physicians,” lead author Douglas O. Staiger told Reuters.

For the study, researchers used census and survey records a decade at a time between 1960 and 2000 to examine data from a sample of 19,688 physicians between the ages of 25 and 70. They also looked at data a year at a time between 2005 and 2011 on a sample collected from 55,381 physicians.

Spouses who had completed six or more years of college before 1990, or a master’s degree or higher after 1990, were considered highly educated.

Researchers found that overall, a mere 5.3 percent of physicians worked in a rural Health Professional Shortage Area (HPSA) between 2005 and 2011, whereas 10.9 percent of the U.S. population lived in these areas. Physicians married to spouses with a masters degree or higher were significantly less likely to work in a rural HPSA compared to other married physicians, with about 4 percent of them working in underserved areas compared to 7 percent of married doctors without a highly educated spouse.

Although there’s an association between physicians marrying highly educated spouses and the distribution of physicians in certain areas, Staiger says a doctor’s marriage habits play a relatively small part in the undersupply of doctors in rural America.

“However, in absolute terms, this does not play a big part in the undersupply of doctors in these areas: Even if physicians with highly educated spouses are located in rural underserved areas at the rate of other married physicians, this would still be small relative to the fraction of the general population living in rural underserved areas,” Staiger told Medical Daily.

The study also found that single physicians were also less likely to work in a rural HPSA, with just 4.1 percent of them choosing to work in an underserved rural area, as were physicians who were young, women, black, or Latino.

Source: Staiger D, Marshall S, Goodman D, Auerbach D, Buerhaus P. Association Between Having a Highly Educated Spouse and Physician Practice in Rural Underserved Areas. JAMA . 2016.